Therapeutic Use:

Indications for KADIAN:

Management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatments are inadequate.

Limitations Of use:

Not for use as an as-needed (prn) analgesic. Use only if alternative treatment options (eg, non-opioid analgesics, immediate-release opioids) are ineffective, not tolerated, or otherwise inadequate to provide sufficient management of pain.

Adult:

Use lowest effective dose for shortest duration. Swallow whole or may sprinkle contents on applesauce. May be given through 16 French gastrostomy tube. Do not give via NG tube. Individualize. May be given on 24hr or 12hr schedule. Usually not for initial therapy; begin with an immediate-release product and convert to an ext-rel product. Opioid non-tolerant: initially 30mg every 24hrs. Adjust dose at 1–2 day intervals. Use 100mg or 200mg caps, a single dose >60mg, or a total daily dose >120mg in opioid-tolerant patients only. Renal failure, cirrhosis: initiate at lower dose; titrate slowly and monitor. Conversion from other morphine formulations or other opioids: see full labeling. Withdraw gradually by 25–50% every 2–4 days.

Children:

<18yrs: not established.

Contraindications:

Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.